Provider Demographics
NPI:1588007843
Name:BIGFORD, BRADLEY ALEXANDER (NP-C)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:ALEXANDER
Last Name:BIGFORD
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44953
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83711-0953
Mailing Address - Country:US
Mailing Address - Phone:208-895-6729
Mailing Address - Fax:208-855-5921
Practice Address - Street 1:745 S PROGRESS AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5619
Practice Address - Country:US
Practice Address - Phone:208-895-6729
Practice Address - Fax:208-855-5921
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1252A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily